Long-term care (LTC) primary care providers (PCPs) and SNF operators just scored a major victory after the Centers for Medicare and Medicaid Services (CMS) agreed to overhaul key pieces of the LEAD model accountable care organization (ACO).

In response to sustained input from the providers and operators, CMS has reshaped two of the most consequential pieces of its new LEAD Model — and the result is a program that finally works the way long-term care needs it to, according to Keith Persinger, CEO, Provider Partners, a national leader in ACOs for skilled nursing and assisted living facilities.

“For years, long-term care providers have watched residents get miscredited to the wrong physician, even when their actual primary care provider — and the SNF operator supporting that care on the ground — were the ones showing up and managing things every day,” he said.

That's now changing.

Persinger said CMS has fixed the underlying issue, ensuring residents are properly matched to the physicians who truly care for them.

“It's a straightforward fix, but a powerful one — it means the doctors and SNF operators doing the real work finally get the recognition, and the resources, which come with it,” he said.

More Winning

The winning doesn't stop there. Persinger said CMS has also overhauled how it sets benchmarks for LTC residents, moving to an approach that reflects the real, current needs of the people being served.

For a population that has historically been undercounted and underrepresented in these models, this is a landmark shift — one that puts SNF operators and the primary care providers who partner with them on much firmer footing and finally gives them credit for the complexity of the care they provide every single day, Persinger said.

"We've been at the table with CMS on this from the start, and it means a great deal to see them respond to what long-term care providers and operators have been telling them," he said. "This is a real win for long-term care — for the primary care providers, the SNF operators, and most of all, the residents they serve. CMS listened, and long-term care is stronger for it."

With the program's next key dates fast approaching, LTC physicians and SNF operators now have a genuine reason for optimism heading into implementation. From where the LEAD Model started to where it stands today, this is a program that has been shaped — for the better — by the people who understand long-term care best, Persinger added.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.